Fatal Pitfall of ST-Segment Elevation: Aortic Dissection

YANG Xiaoyan.

doi:null

您当前的位置：

首页 >

文章列表页 >

Fatal Pitfall of ST-Segment Elevation: Aortic Dissection

Special Feature | 更新时间：2026-03-30

- Fatal Pitfall of ST-Segment Elevation: Aortic Dissection
- J Clin Electrocardiol Vol. 35, Issue 1, Pages: 6-11(2026)
- 作者机构：
  
  410300 湖南浏阳，浏阳市人民医院心血管内科
- 作者简介：
- 基金信息：
- DOI：
  CLC： R541.7　R540.4+1
- Received：24 January 2026，
  
  Accepted：29 January 2026，
  
  Published：28 February 2026
- 稿件说明：
移动端阅览
杨小燕. ST段抬高的致命陷阱：主动脉夹层[J]. 临床心电学杂志, 2026, 35(1): 6-11.

YANG Xiaoyan..Fatal Pitfall of ST-Segment Elevation: Aortic Dissection[J].J Clin Electrocardiol,2026,35(01):6-11.
杨小燕. ST段抬高的致命陷阱：主动脉夹层[J]. 临床心电学杂志, 2026, 35(1): 6-11. DOI：

YANG Xiaoyan..Fatal Pitfall of ST-Segment Elevation: Aortic Dissection[J].J Clin Electrocardiol,2026,35(01):6-11. DOI：

摘要

40岁男性患者，突发持续性胸痛伴心电图广泛前壁、高侧壁ST段抬高。初期拟诊为急性心肌梗死并给予双联抗血小板治疗。但结合其双侧血压不对称、心电图ST段迅速回落、肌钙蛋白阴性而血浆D-二聚体显著升高（>10，000 ng/mL）等特征，高度怀疑急性主动脉综合征。主动脉CTA检查确诊为Stanford A型主动脉夹层累及左冠状动脉主干开口，患者成功接受手术后康复。急性主动脉夹层是一种致命性心血管急症，其临床表现常与急性冠脉综合征重合，极易导致误诊和不恰当的抗血小板治疗，进而增加致命性出血风险和死亡率。2024年ESC指南推荐，结合主动脉夹层检测风险评分（ADD-RS）与D-二聚体检测的多参数诊断策略可高效分流患者：对于低风险患者，D-二聚体阴性可有效排除夹层；对于中高风险患者，应立即进行确诊性影像检查以避免漏诊。胸痛患者的标准化的早期识别流程，是避免致命性延误，改善A型主动脉夹层患者预后的关键。

Abstract

A 40-year-old male patient presented with sudden-onset persistent chest pain accompanied by widespread anterior ST-segment elevation on electrocardiogram (ECG). Initially diagnosed as acute myocardial infarction (AMI)

he received dual antiplatelet therapy. However

a combination of clues including bilateral blood pressure asymmetry

rapid ST-segment resolution

negative troponin but strikingly elevated plasma D-dimer (>10

000 ng/mL) raised a high suspicion of acute aortic syndrome. Aortic computed tomography angiography (CTA) confirmed Stanford type A aortic dissection involving the left main coronary artery ostium. The patient underwent successful surgical repair. Acute aortic dissection(AAD)

particularly type A

is a life-threatening cardiovascular emergency. Its clinical presentation often overlaps with acute coronary syndrome (ACS)

leading to misdiagnosis

inappropriate antiplatelet therapy

and increased risk of catastrophic hemorrhage and mortality. The 2024 ESC guidelines recommend a multi-parameter diagnostic strategy combining the Aortic Dissection Detection Risk Score (ADD-RS) and D-dimer testing for efficient patient triage. For patients with low clinical risk

a negative D-dimer can effectively rule out dissection; for those with intermediate to high clinical risk

immediate confirmatory imaging is required to avoid diagnostic delay. Implementing a standardized early recognition algorithm for patients with chest pain is paramount to preventing fatal delays and improving outcomes in patients with type A aortic dissection.

关键词

Keywords

references

HARRIS K M , NIENABER C A , PETERSON M D , et al . Early mortality in type A acute aortic dissection: insights from the international registry of acute aortic dissection [J ] . JAMA Cardiol , 2022 , 7 ( 10 ): 1009 - 1015 .

MUSSA F F , HORTON J D , MORIDZADEH R , et al . Acute aortic dissection and intramural hematoma: a systematic review [J ] . JAMA , 2016 , 316 ( 7 ): 754 - 763 .

LUO J L , WU C K , LIN Y H , et al . Type A aortic dissection manifesting as acute myocardial infarction: still a lesson to learn. Heart [J ] . Acta Cardiol , 2009 , 64 ( 4 ): 499 - 504 .

KOSUGE M , UCHIDA K , IMOTO K , et al . Frequency and implication of ST-T abnormalities on hospital admission electrocardiograms in patients with type A acute aortic dissection [J ] . Am J Cardiol , 2013 , 112 ( 3 ): 424 - 429 .

KOSUGE M , KIMURA K , UCHIDA K , et al . Clinical implications of electrocardiograms for patients with type A acute aortic dissection [J ] . Circ J , 2017 , 81 ( 9 ): 1254 - 1260 .

SHAPIRA O M , DAVIDOFF R . Functional left main coronary artery obstruction due to aortic dissection [J ] . Circulation , 1998 , 98 ( 3 ): 278 - 280 .

中华医学会心血管病学分会大血管学组 , 中华心血管病杂志编辑委员会 . 急性主动脉夹层合并冠心病的诊断与治疗策略中国专家共识 . 中华心血管病杂志 , 2021 , 49 ( 11 ): 1074 - 1081

ERBEL R , ABOYANS V , BOILEAU C , et al . 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC) [J ] . Eur Heart J , 2014 , 35 ( 41 ): 2873 - 2926 .

HANSSON E C , DELLBORG M , LEPORE V , et al . Prevalence, indications and appropriateness of antiplatelet therapy in patients operated for acute aortic dissection: associations with bleeding complications and mortality [J ] . Heart , 2013 , 99 ( 2 ): 116 - 121 .

MAZZOLAI L , TEIXIDO-TURA G , LANZI S , et al . 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases [J ] . Eur Heart J , 2024 , 45 ( 36 ): 3538 - 3700 .

ISSELBACHER E M , PREVENTZA O , HAMILTON BLACK J 3 RD, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines[J ] . Circulation , 2022, 146 ( 24 ): e334 - e482 .

WANG Y , TAN X , GAO H , et al . Magnitude of soluble ST2 as a novel biomarker for acute aortic dissection [J ] . Circulation , 2018 , 137 ( 3 ): 259 - 269 .

MOORE A G , EAGLE K A , BRUCKMAN D , et al . Choice of computed tomography,transesophageal echocardiography, magnetic resonance imaging, and aortography in acute aortic dissection: International Registry of Acute Aortic Dissection (IRAD) [J ] . Am J Cardiol , 2002 , 89 ( 10 ): 1235 - 1238 .

ROGERS A M , HERMANN L K , BOOHER A M , et al . Sensitivity of the aortic dissection detection risk score,a novel guideline-based tool for identification of acute aortic dissection at initial presentation: results from the international registry of acute aortic dissection [J ] . Circulation , 2011 , 123 ( 20 ): 2213 - 2218 .

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

ST-Segment Elevation in the Precordial Leads: A Vector Masquerade — Analysis and Clinical Implications of Electrocardiographic Misinterpretation

Analysis of the prognostic value of QRS duration combined with SII index in patients with acute myocardial infarction undergoing percutaneous coronary intervention

Predictive value of hs-cTnI for major adverse cardiovascular events in patients with acute myocardial infarction

Application of Tifelban combined with Simvastatin after PCI in young and middle-aged patients with acute myocardial infarction and its effect on quality of life and TIMI blood flow grading

The value of electrocardiography in the diagnosis of myocardial infarction related scar

Related Author

ZHANG Bin

WU Xiangshu

YANG Yuqin

CHEN Zhenyi

ZHAO Jingkun

Zhang zenghui

Yang guanghui

Zhang songchuang

Related Institution

Department of cardiology, Jiangmen central hospital

Department of Cardiology, Lianjiang County General Hospital, Lianjiang

Department of Cardiology, Henan Provincial Hospital of Traditional Chinese Medicine

Department of Cardiology, Anyang District Hospital

Department of Cardiology, Second People’s Hospital of Henan Province

⁰